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Nursing pain - help :/

Hi, my second DS is 10 days old today and I've been experiencing terrible nipple pain since day 3. Both my nipples are cracked at the tip so 2 days ago I decided to nurse from the less damaged breast only, and I pump the other at every feeding. After he nurses I give him the expressed breastmilk from the bottle (one from medela, that is supposed to prevent nipple confusion).

I had 2 LC tell me the latch is fine (probably improved a little). However my nipples are shaped like lipstick at the end of the feeding, instead of pensil erasers.
When I use the football hold they end up with the pencil eraser shape, BUT it s equally painful!

I m also using lanolin, breastshells, BM on the nipples, hydrogel pads and advil for the pain.
Tried nipple shield but its worse and milk doesn t transfer well.

What I would like to know is:

- If the latch is now correct, how long for it to stop hurting? Should I pump and let the nipples heal? (I m terrified he ll refuse the breast afterwards). should I keep nursing and wait until nipples toughen up?

I am really desperate, I was so looking forward to this experience and now I feel like crying at every feeding... I know its christmas and everybody is probably very busy, but I am desperate for a piece of advise. Thank tou so much!

Re: Nursing pain - help :/

Welcome and congratulations on the new baby! It sounds like his latch is still too shallow- that's what's causing the lipstick nipples. Instead of the nipple landing deep in the baby's mouth, between the tongue and soft palate, it's landing in the front of the mouth, between tongue and hard palate, where it's getting squished. And yes, it's quite possible to have a latch that looks good on the outside and feels awful on the inside.

Here's what I suggest:
1. Use the football hold exclusively for now. I know it hurts, but when you have badly cracked nipples everything is going to hurt. The symmetrical nipple shape you get with the football hold implies that it's the best latch for you right now, and using the best latch should speed healing.
2. Before nursing, try immersing your nipples in a shot glass of warm water. This will hydrate the cps cabs on the cracks, making them less painful when they reopen.
3. Use lanolin ointment on the cracks- moist skin heals faster.
4. Use a combination of 1% hydrocortisone cream and Bacitracin ointment on the cracks, to combat inflammation and infection. Use a pea-sized amount, mixed and applied with a clean finger. Does not need to be washed off prior to nursing.
5. Crank up the humidity in your house. Dry air makes cracks worse.
6. Go bra-less/topless as much as possible to reduce chafing.
7. If you are in severe pain after feeding, try putting a warm water bottle or rice sock over the nipple- you may be experiencing a vasospasm due to compression of the nipple. http://kellymom.com/bf/concerns/mom/...blanching.html
8. If nursing is unendurable, you can take a break from nursing and allow your nipples to heal. However, with such a young baby, taking a break is always accompanied by the risk that the baby will not go back to the breast. I strongly advocate keeping the baby at the breast for at least 1-2 feedings every day if you choose this path!
9. Google "nipple sandwich technique" for a description of a method which can help you cram the maximum amount of breast into baby's mouth.
10. Be patient! Your baby's latch will improve as he grows and his mouth gets bigger. I promise! My first kid tore my nips up so badly that my LC said they were the "second worst" she had ever seen in her long, long career. And they did eventually heal, and I went on to nurse my baby for 3 years.

I know this is hardly the way you want to spend your baby's first Xmas, but you will get through this, mama. What you're going through now is the ugly wrapping paper on the outside of the most beautiful gift you and your baby could ever get.

Re: Nursing pain - help :/

Hi there, I just wanted to say please don't give up ! I went through a painful first few weeks too and even after we got our latch right, it did take a little time to heal (great tips in the above post) so it would hurt for 30 seconds or so initially at every feed. I would breathe thru the pain like they tell you at birthing class for contractions :-). Stuck with it, no pumping or bottles and from about 8 or 10 weeks its been so much easier and I enjoy it now. You'll get thru it, this forum is great for tips and advice too!

Re: Nursing pain - help :/

Mommal always gives amazing advice. I'd listen to her.

My breasts took the same beating early on. I didn't want to pump and risk confusion. You can take both Advil and Tylenol to help manage pain. I also took some of the meds they gave me after I gave birth to deal with it. I know you said you are already doing that. Just letting you know, it's what I also did.

Christine
Baby Girl Born 2/17/10 to her two mommies
BF from day one. I looked up one day and realized I'm nursing a toddler!

Re: Nursing pain - help :/

I had 2 LC tell me the latch is fine (probably improved a little). However my nipples are shaped like lipstick at the end of the feeding, instead of pensil erasers.
When I use the football hold they end up with the pencil eraser shape, BUT it s equally painful!

I just want to point out that this makes my nuts. It does not matter what the latch looks like, if it hurts, something is not right. Now, it is perfectly OK for an LC to look at a baby who is nursing, and say something like "mmm-that latch looks fine." But they should also ask mom how it is feeling and if she says it hurts, then they should suggest an adjustment. Latch can be is tricky, and sometimes getting there takes time, and an LC, no matter how good she is, is not always going to have a solution. But I certainly hope you don't mean they said the latch 'looks fine" and left it at that while you writhed in pain. Of course, If you already have severe nipple damage, as mommal says, everything is going to hurt until the nipples start to heal. So maybe that is what is going on. However, I would think it would feel slightly better when baby is latching OK.

OK, rant over. I am sure that was not helpful but I just want to encourage you to keep fiddling with positioning and latch until it starts to be comfortable for you no matter what anyone says about how it looks. How it looks is only part of the story and not the most important part.

The only thing I would add to what mommal said is to consider trying laid back breastfeeding. This can be very helpful for painful latch in young babies, plus it is a comfortable and supported position for mom, very important for tired mommies in early days. Just something else to try.

Oh and you don't need to stop nursing for your nipples to heal. If the latch is good, you can heal while nursing. However, sometimes moms do feel they need to stop (or cut down) for a day or two while they heal. It is really up to you. Just make sure you pump frequently so your milk supply can live to fight another day. You could also cup feed (best) or use paced bottle feeding (better than traditional bottle feeding) to help prevent nipple confusion which would make matter worse.

Re: Nursing pain - help :/

Thank you all for all the helpful advice. It feels better knowing you were able to get trough this rough patch. I used the football hold for every feeding yeasterday, and I seemed to be doing better. Today however I am at my worst again. It seems that if I get it wrong once, I m back to square one again. Is there anything I can do to get his mouth to open wider?

Re: Nursing pain - help :/

It's tough with a little baby! Their mouths are so tiny. Even when they are open as wide as they can be, it can still be hit-or-miss for mom, in terms of pain. Getting the baby to open wider is tricky. It may help to show him what you want to do, by opening yur mouth really wide. Even newborns will sometimes imitate a parent's facial expression. It may also help to try to latch before he's truly hungry. Screaming, frantic, hungry babies often open and shut their mouths really fast, and it's hard to get a breast into that moving target. If he does become frantic, offer your pinky finger with nail held down towards his tongue (a fingernail can damage the sensitive palate) and let him suck on that for a few seconds. It may calm him enough to enable a second latching attempt.

It's fairly normal to feel like you're making progress and then slip back. Badly damaged nipples may start to heal only to get torn open once again. You just have to keep working at the latch, and working and working...

As LLLMeg said, experimenting with different positions may help. A lot of moms have success with reclined positions. I personally had the best luck with the side-lying position- I could use the bed to support the baby and also the breast. If you have larger, heavier breasts, tucking a rolled-up washcloth beneath your breast may help prop it up into an easier position.

Re: Nursing pain - help :/

to pp. esp: Nurse before baby is hungry! Watch the video I posted above on laid back, if nothing else to see how a baby begins to cue right in his sleep. Also, one reason the football hold is helpful is because it allows mom to better visualize latch-so what are you trying, in order to get a 'gape?" Besides mom modeling for baby, I have seen stroking baby’s lips (upper and/or lower) with your nipple (or finger) work. Here is a video that may be helpful in understanding what one is trying to achieve for a “good” latch. http://www.youtube.com/watch?v=Zln0LTkejIs

One issue with football or any sitting up hold is mom tends to press on the back of baby’s head, and this makes baby pull off, or partially pull off, causing a shallow latch or pull off damage. If you have your hand or fingers on your babies head, move them down to the shoulders. You baby has more head control that you think.

Now, the interesting thing about laid back/reclined type positions are, you are not necessarily going to need to get a "good gape" that you then aim your nipple into for an “asymmetric” or “deep” latch. Babies in this position can often "self attach." (This often requires some help from mom getting them lined up "right"-and that means, whatever is right for you and baby, but usually that means draping baby on you so that baby's mouth is slightly below the nipple-(or just beside teh nipple, if you have babyy across your body) so, like nose to nipple, and then encouraging/directing baby as needed. It will likely feel fumbly and awkward at first.) In laid back, you may or may not need to shape your breast for baby, but you should not need to work so hard to get baby to gape when in a reclined position. In theory, this position allows the baby’s instincts to come to the fore and they just get on with it. In other words, when a baby more or less self attaches, this tends to allow baby to get a good latch without trying so hard. Of course, you can also combine the two ideas by using a modified football hold in a reclined position, or getting baby latched on and THEN reclining.

Count me as one of those moms who had severe nipple injury (open, bleeding cracks, ugh) in the early days with my oldest and went on to nurse just fine. It took time, patience (with myself, baby, and the world) lots of support from my husband, and 2 Lactation Consultants. I also think it took some sheer cussedness on my part. But somehow, we did it and to me, it was worth every bit of pain (of nipples and wallet) 100 times over. All I can say is-it does get better.

Have you contacted your local La Leche League Leader(s)? You local Leaders can offer free phone help, free support meetings, some Leaders even do home visits, which would also be free.

Re: Nursing pain - help :/

I live in Portugal and we don´t have a tradition of lactation consultants. There are a few but I m under the impression they are not very experienced. For my first son I had a LL leader coming to my house because he wouldn t latch on, and I can tell you it wasn´t helpful at all (wasn't free either :P). I do have a friend who is a LC, she came to see the latch a few days ago and said it was fine. No matter how much of the areola I manage to get in his mouth, it always hurts like hell :/

Today I went to my OB and she advised me to pump for a week to let the cracks heal and feed the baby by bottle. I said I was too afraid he would refuse the breast afterwards but she wasn't concerned. Pediatrician said the same thing. Said something like "you have to be reasonable"... It's really bringing me down...

Re: Nursing pain - help :/

Sometimes "you have to be reasonable" is code for "just do what I say and stop bugging me, already!" You do NOT have to be "reasonable". When my first was a newborn and I was having problems which were very similar to yours, a lot of people said that the reasonable thing to do was to just give up and switch to formula. I am so glad I did not take their advice!

Ultimately, only you can weigh the risks and benefits and come up with the right answer about what is reasonable. If you do decide to pump for a while, and give yourself a chance to heal, you can. You know the risk. There are ways to minimize it, though! You can keep the baby at the breast for some feedings, and feed your baby in ways that make it more likely that he will be able to transition back to nursing full-time.